title: Moderate-severe traumatic brain injury causes delayed loss of white matter integrity: evidence of fornix deterioration in the chronic stage of injury.
abstract: OBJECTIVE
  To examine structural integrity loss in the fornix from 5-30 months after moderate and severe traumatic brain injury (TBI) using diffusion tensor imaging.
  
  
  METHODS
  MRIs were prospectively undertaken in 29 adults with moderate and severe TBI at two time points. Fractional anisotropy (FA) was calculated for the fornix (column/body, right crux and left crux) at 5 and 30 months post-injury.
  
  
  RESULTS
  Paired t-tests revealed significant FA reductions with large effect sizes across time in the column/body, p < 0.001, right crux, p < 0.001 and left crux, p < 0.001.
  
  
  CONCLUSIONS
  These data contribute to the growing body of evidence that loss of white matter continues in moderate and severe TBI even after the acute neurological effects of TBI have resolved. As the fornix plays a critical role in memory, this may be a contributing factor to the poor clinical outcomes observed in these patients.
authors.affiliation: Toronto Rehabilitation Institute , Toronto, ON , Canada .
authors.forename: Areeba
authors.initials: A
authors.lastname: Adnan
authors.forename: Adrian
authors.initials: A
authors.lastname: Crawley
authors.forename: David
authors.initials: D
authors.lastname: Mikulis
authors.forename: Morris
authors.initials: M
authors.lastname: Moscovitch
authors.forename: Brenda
authors.initials: B
authors.lastname: Colella
authors.forename: Robin
authors.initials: R
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D001930:Brain Injuries / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D020712:Fornix, Brain / Q000473:pathology* / Q000503:physiopathology; D015600:Glasgow Coma Scale; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015601:Injury Severity Score; D056784:Leukoencephalopathies / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D013997:Time Factors